RN Case Manager – Behavioral Health

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Extract, organize, and evaluate data to assess member eligibility for the Population Health Management Program.

• Coordinate and deliver timely, effective, equitable, safe, and member-focused care while adhering to HMO protocols.

• Oversee case assignments, which include outreach, documentation, monitoring case progression, and case closure.

• Fulfill reporting and documentation standards.

• Engage in collaborative meetings with department personnel and clients.

• Address barriers, social determinants, member motivators, and psychosocial factors to enhance member wellness and health autonomy.

• Educate members on how to navigate the HMO and healthcare system.

• Advocate for quality and cost-effective interventions and outcomes.

• Support operational activities to fulfill customer requirements and enhance satisfaction.

• Ensure the confidentiality of computer programs, medical records, and data.

• Participate in QM/UM Committee Meetings, including preparing materials, taking minutes, collecting and analyzing data, reporting, and following up on tasks.

• Join off-hour/weekend call rotations if applicable.

• Maintain ongoing professional development and education in line with current nursing practices and the Illinois Practice Act.

• Execute additional responsibilities as assigned according to annual program requirements.

⛳️ Requirements

• Valid Illinois Registered Nurse License.

• Complete 20 hours of continuing education every 2-year Illinois license renewal cycle.

• A minimum of five years of experience across various healthcare settings.

• Extensive expertise in case management and chronic condition management.

• Understanding of utilization review, quality improvement, managed care, and/or community health.

• Prior experience in remote and/or telephonic roles.

• Fundamental knowledge of case management principles, healthcare management, and reimbursement processes.

• Familiarity with motivational interviewing techniques.

• Exceptional clinical judgment.

• Highly proficient in both verbal and written communication.

• Strong organizational, problem-solving, and time-management capabilities.

• Ability to complete projects and assignments within deadlines.

• Capability to prioritize and respond to rapidly changing business demands.

• Ability to work independently and remotely while managing multiple tasks in fast-paced environments.

• Competency in software applications including MS Word, Excel, Access, PDF, Outlook, word processing, and spreadsheets.

• Experience navigating various EMR systems.

• High-speed, secure home internet connection.

• Private HIPAA-compliant home office with a lockable door.

• Backup internet connection options available.

• Certification in Case Management is preferred but not mandatory.

🏝️ Benefits

• Fully remote work arrangement.

• Medical, dental, and vision plans.

• 401(k) plan featuring a 3% employer match to the employee’s 6% contribution.

• Life and disability insurance.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Access to learning and development resources.

• Necessary work equipment provided free of charge.

• Full-time employees working 30 hours per week or more qualify for comprehensive benefits.